七氟醚缺血前期和再灌注早期处理对心脏瓣膜置换术患者血清TNF-α、IL-8及SP-A的影响

发布时间：2018-05-07 02:04

本文选题：体外循环 + 七氟醚　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:以对肺损伤的敏感的SP-A和炎症因子IL-8、TNF-α,结合术中和术后的血流动力学及血气参数为观测指标,观察缺血前期和再灌注早期吸入七氟醚对瓣膜置换术患者血清中TNF-α、IL-8和SP-A的影响和意义,研究缺血前期和再灌注早期吸入七氟醚在CPB后肺损伤的保护机制。方法:选择择期行二尖瓣或者主动脉瓣膜置换的患者40例,年龄30~65岁,体重47~81kg,性别不限,ASA分级II或者III级,采用随机数字表法分为七氟醚组(S组)和对照组(C组),每组20例。两组均采用全静脉麻醉,S组患者在夹毕和开放升主动脉前后各吸入2%七氟醚15min,C组整个过程不吸入七氟醚。分别于切皮前(T0)、体外循环前(T1)、主动脉开放后30min(T2)、开放后2h(T3)、开放后6h(T4)、开放后24h(T5)取桡动脉血检测动脉血气并计算肺泡动脉血氧分压差P(A-a)O2、氧合指数OI;并测得T0、T1、T2、T3、T4、T5的动脉血清中炎性因子白细胞介素8(Interleukin 8,IL-8)和肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)的水平。在T1、T2时刻分别抽取右心室(近似肺动脉)、左心房(近似肺静脉)血测得中性粒细胞(NEV,NEA)和肺泡表面活性物质A(SP-AV,SP-AA),计算肺动静脉之间两者之间的差值(NEV-A,SP-AV-A),反映了肺内净生成了NE和净释放SP-A。结果:1、两组患者体重、年龄、CPB时间、主动脉阻断时间、机械通气时间、ICU停留时间未见明显差异(P0.05)。两组各个时刻的MAP和HR无明显差异(P0.05)。2、与C组比较,S组在T2、T3、T4时P(A-a)O2、IL-8和TNF-α明显低于C组,OI明显高于C组(P0.05),在T0、T1、T5时两组P(A-a)O2、OI、IL-8和TNF-α差异无统计学意义(P0.05);与T0相比,两组P(A-a)O2、IL-8和TNF-α在T1时开始升高,T3时达到高峰后降低,OI在T1开始降低,T3时达到最低点后回升(P0.05)。3、与C组比较,在T1时两组NEV、NEA、SP-AV、SP-AA没有明显差异(P0.05),在T2时S组明显低于C组(P0.05);与T1时相比,T2时刻两组NEV、NEA、SP-AV、SP-AA都明显升高(P0.05)。结论:1、与不吸入七氟醚相比,缺血前期和再灌注早期吸入七氟醚能降低炎症因子TNF-α、IL-8的水平,减少SP-A的释放入血。2、与不吸入七氟醚相比,七氟醚组患者的保持了较低的P(A-a)O2和较高的OI,可能减轻CPB后肺损伤,有利于肺保护。
[Abstract]:Objective: to observe the sensitivity of SP-A and IL-8 TNF- 伪 to lung injury, combined with hemodynamics and blood gas parameters during and after operation. To observe the effect and significance of inhaling sevoflurane before ischemia and early reperfusion on TNF- 伪 IL-8 and SP-A in serum of patients undergoing valvular replacement, and to study the protective mechanism of sevoflurane inhalation before ischemia and early reperfusion on lung injury after CPB. Methods: forty patients with mitral valve or aortic valve replacement, aged 30 to 65 years, weighing 4781 kg, were randomly divided into sevoflurane group (group S) and control group (group C, n = 20). Both groups were treated with total intravenous anaesthesia before and after clamping and opening of ascending aorta. The patients in group C did not inhale sevoflurane during the whole process of inhaling 2% sevoflurane for 15 min before and after clamping and opening the aorta. The radial artery blood was collected to detect arterial blood gas and calculate the oxygen pressure difference (PA-aO _ 2) of alveolar artery, oxygen index Oi, and the arterial blood level of T0 T _ (1) T _ (2) T _ (2) T _ (3) T _ (3) T _ (3) T _ (3) T _ (3) T _ (3) T _ (5), the arterial blood of T0 T _ (1) T _ (1) T _ (2) T _ (3) T _ (3) T _ (4) T _ (5), the arterial blood level of T0 T _ (1) and T _ (3) T _ (3) T _ (4) T _ (5) were measured. The levels of Interleukin-8 (IL-8) and tumor necrosis factor 伪 -Tumor necrosis factor 伪 (TNF- 伪) were measured. The right ventricle (near pulmonary artery, left atrial neutrophil nevo nea) and alveolar surfactant Agna were drawn at T 1 and T 2 to calculate the difference between the pulmonary arteriovenous and pulmonary arteries and veins, which reflects the intrapulmonary neophysiological changes in neutrophil nevnea and alveolar surfactant SP-AAA. NE and net release SP-A. Results there was no significant difference in weight, age, CPB time, aortic occlusion time, mechanical ventilation time and ICU stay time between the two groups (P 0.05). There was no significant difference in MAP and HR between the two groups at different time points (P 0.05). There was no significant difference in MAP and HR between group C and group C (P 0.05). Compared with group C, there was no significant difference in IL-8 and TNF- 伪 between the two groups at T2T3T4 and TNF- 伪, and there was no significant difference between the two groups at T0 / T1T5, compared with T0. The levels of IL-8 and TNF- 伪 in both groups began to increase at T1 and reached the peak at T1, and then decreased at the beginning of T _ 1 and reached the lowest point when T _ 1 began to decrease, and then rose up to P _ (0.05) O 路3, compared with those in group C, and compared with those in group C, the levels of TNF- 伪 and TNF- 伪 increased. There was no significant difference in SP-AVSP-AA between the two groups at T1, but at T2, the level of SP-AVSP-AA in group S was significantly lower than that in group C (P0.05A), and that in the two groups at T _ 1 and T _ 2 was significantly higher than that in group C (P 0.05). Conclusion compared with those without sevoflurane, inhaling sevoflurane before ischemia and early reperfusion can reduce the level of inflammatory factor TNF- 伪 and IL-8 and decrease the release of SP-A into blood. The patients in sevoflurane group maintained lower P(A-a)O2 and higher OI, which may reduce lung injury after CPB and be beneficial to lung protection.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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